UKESAD: Delegate Booking Form

7th UK/EUROPEAN SYMPOSIUM ON ADDICTIVE DISORDERS
Grange City Hotel, 8-14 Cooper's Row, London EC3N 2BQ
13,14,15 May 2010.

Meet friends, make friends, learn, earn CEUs.

Simply fill in the form below to ensure delegate entry to UKESAD. Call 020-7233 5333 or email info@ukesad.org if you have any queries.

For delegates who pay by 31 March 2010:

the subsidised rate for voluntary organisations is £140/day or £335 for 3 days (compared to £154 and £375)
the rate for public/private-sector organisations is £154/day or £375 for 3 days (compared to £195/£425).

We can email you an invoice specific to your requirements with details of how to pay by cheque, card or online.

Contact Details

First Name *

Last Name *

Title (e.g Mr, Ms, Mrs etc) *

Job Title *

Telephone (including code) *

Email (booking confirmation will be sent here) *

Organisation *

Organisation Type *

Contact Address

Address Line 1 *

Address line 2

Town/City *

County/State *

Postal Code *

Country *

When will you attend? * 13 May 2010
14 May 2010
15 May 2010

Payment Details

Purchase order no. (if applicable)

Invoice Address (If different from above)

Address Line 1

Address line 2

Town/City

County/State

Postal Code

Country

Any special access requirements?

Any special dietary requirements?

Additional Comments

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